Threat to AIDS funding will continue past contentious FY 96 budget battles

"I have known what the Greeks did not: uncertainty."

Jorge Luis Borges

Ficciones

With the start of a new fiscal year, advocates for the AIDS community usually take a well-deserved breather from daily fighting for funding for every federal program linked to AIDS, and shift gears in preparation for the battle for AIDS funding in the year ahead. Not so going into the fourth month of fiscal year 1997. Unfortunately, the only answer we in Washington can give to the question, "What can we expect to happen to AIDS research, care and prevention funding in fiscal year 1997?" is, "We'll let you know just as soon as President Clinton and the Congress can agree on fiscal year 1996."

Uncertainty is not new to AIDS advocates. At times it has come to be a state of mind. But never has the advocacy community experienced the level of uncertainty (read also: frustration) that we now are experiencing with the on-again, off-again budget negotiations, impasse, or stalemate (the terms change daily) in which the GOP congressional leadership and the Clinton administration appear to be engaged.

President Clinton and the GOP congressional leadership agreed on November 19, 1995, to balance the federal budget by 2002 using Congressional Budget Office estimates, provided the budget protects programs for health care (chief among them Medicaid), the environment, and education. The commitment to these programs and to the fundamental humanitarian values they embody - commitments to which both sides agreed, at least on paper - are every bit as important as the nation's need for fiscal control. Despite this written agreement, which was signed by President Clinton as a condition for re-opening the government during the first federal shutdown, the federal government is again shut down and more than 250,000 federal employees sit at home waiting for budget negotiators to negotiate in good faith and desist from engaging in partisan attacks against one another. Two weeks into the second (and longest in history) federal government shutdown, we do not know if there will be more continuing resolutions to re-open the government. The two sides may never agree on the particulars of a seven-year balanced budget plan, and key issues such as the fate of the Medicaid health care safety net program hang in the balance. Indeed, Medicaid's future has emerged as a primary point of ideological disagreement between the President and Congress. The congressional leadership seeks block grants and thus a final end to poor people's entitlement to basic health care. The White House, meanwhile, seems equally wedded to preserving Medicaid in roughly its present form. There is even greater uncertainty about whether GOP congressional leaders and President Clinton are even willing to breach the philosophical gulf, exacerbated by partisan politics, of how to balance the federal budget.

Perhaps one of the only certainties in this equation is that in any scenario, the AIDS community faces great threats to the already insufficient funding appropriated for the programs that keep people with AIDS alive, attempt to prevent the further transmission of this virus, or find a way to end this 15-year-old pandemic. It has become clear in these ongoing budget negotiations that both the Republicans and the Democrats have embraced the concept of a balanced budget. Whether politically expedient or fiscally responsible, the embracing of the balanced budget concept will undoubtedly hurt, directly or indirectly, AIDS programs because as government tightens its belt, among the first programs to feel the budget scalpel will be domestic discretionary programs. Most important, under every budget scenario under consideration, domestic discretionary spending will be severely restricted in all fiscal years between 1996 and 2002. Since all major categorical AIDS funding - CDC prevention, Ryan White, NIH research, and AIDS housing (HOPWA) - falls into this "discretionary" category, all AIDS funding will be at serious risk in all foreseeable federal fiscal years. Our challenge as advocates for people with AIDS will be to try in increasingly fiscally conservative times to preserve the integrity of our vital programs, and to safeguard an already fragile AIDS care infrastructure.

There is one certainty, however, that must guide our efforts: Beyond the politics and budget projections, countless human lives, including those of people living with HIV/AIDS, are at stake. As our elected officials on both sides of the political aisle negotiate America's future and that of the programs that benefit so many Americans, they must do so with the understanding that the end-result of their negotiations, although pleasing on paper in the form of diminished expenditures, could mean needless pain and hastened deaths for millions of America's most vulnerable citizens. America cannot afford, nor should it even consider, paying that hefty price.

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Mark Barnes is executive director of AIDS Action Council. Founded in 1984, AIDS Action represents more than 1,000 community-based AIDS service organizations nationwide, and is the only national organization devoted solely to lobbying the federal government on AIDS policy, legislation and funding.